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Chapter Twelve
Importance of Noncommunicable
Disease
The Importance of Noncommunicable
Disease
• Growing importance worldwide
• Burden of noncommunicable diseases greater
than burden of communicable diseases in low-,
middle-, and high-income countries
• Cardiovascular disease, diabetes, cancer, and
mental disorders are most important in lowand middle-income countries
• Often prevented at low cost, but expensive to
treat
Key Definitions
• Noncommunicable disease cannot be spread
by an infectious agent, they last a long time
and they are often disabling
• Include cancers, diabetes, endocrine disorders,
neuropsychiatric disorders, and sense organ
disorders
The Burden of Noncommunicable
Diseases
Cardiovascular disease
• Cause of about 30% of all deaths worldwide
• Leading cause of death in low- and middleincome countries, and high-income countries
• Rates vary by region
• 80% of burden of CVD is due to ischemic
heart disease, stroke, and congestive heart
failure
The Burden of Noncommunicable
Diseases
Diabetes
• 200 million people worldwide suffer from
diabetes
• Loss of 20 million DALYs per year
• Prevalence is rapidly increasing due to obesity
• Costly complications including blindness, kidney
failure, amputation of lower extremities, stroke,
and others
• 2/3 of people with diabetes have a disability
compared to less than 1/3 of the people without
The Burden of Noncommunicable
Diseases
Cancer
• Most important worldwide are lung, colon, breast,
prostate, liver, stomach, and cervix
• 7 million cancer deaths and 10 million new cases
each year
• More likely to be associated with tobacco use,
environmental factors and lifestyle in highincome countries
• More likely to be associated with an infectious
agent in low-income countries
The Burden of Noncommunicable
Diseases
Mental Disorders
• Includes neurological disorders like epilepsy,
drug and alcohol abuse, and mental disorders
• Responsible for 10% of DALYs lost in low- and
middle-income countries
• Start at relatively young ages, go on for a long
time, often cannot be cured, and produce large
amounts of disability
• Unipolar depressive disorders are growing in
importance
The Burden of Noncommunicable
Diseases
Vision and Hearing Loss
• Aging of populations globally and improved life
expectancy increase importance
• Vision loss responsible for 3.3% of the burden of
disease
• Hearing loss responsible for 1.7% of the burden
of disease
• Projected to be in top 10 causes of the burden of
disease in 2030
The Burden of Noncommunicable
Disease
Tobacco Use
• 5 million deaths annually associated with tobacco use,
half of those in low- and middle-income countries
• Most common tobacco-related deaths are CVD,
diseases of the respiratory system, and cancer
• Rates of smoking vary by region and across regions
according to sex, age, socioeconomic status, and other
factors
• Usage increasing in men in low- and middle-income
countries and women in all regions
The Burden of Noncommunicable
Disease
Abuse of Alcohol
• Responsible for 4% of burden of disease
• Increases risk for hypertension, liver damage,
heart disease, and other problems
• Intoxication associated with injuries and high-risk
sexual encounters
• Prevalence of high-risk drinking varies by region
with men in Europe and Central Asia having the
highest rates
The Costs and Consequences of
Noncommunicable Diseases, Tobacco Use and
Alcohol Abuse
• Direct costs of treatment
• Indirect costs from lost productivity
• Low-income countries are simultaneously
facing burden of communicable diseases and
noncommunicable diseases
The Costs and Consequences of
Noncommunicable Diseases, Tobacco Use
and Alcohol Abuse
Cardiovascular Disease
• Study found that men die 56% more at the same
age of CVD than men in high-income countries
and women die 86% more at the same age of
CVD than women in high-income countries
• Estimated that the countries involved would lose
$84 billion in economic production between 2006
and 2015 from CVD
The Costs and Consequences of
Noncommunicable Diseases, Tobacco Use
and Alcohol Abuse
Diabetes
• Cost of treating diabetes varies between 2.5%
and 15% of health expenditures in different
countries
• Latin America and the Caribbean have highest
expenditures, sub-Saharan Africa has the
lowest
• Indirect costs are probably high because many
people do not receive proper treatment
The Costs and Consequences of
Noncommunicable Diseases, Tobacco
Use, and Alcohol Abuse
Mental Disorders
• Little data from low- and middle-income
countries indicative of unappreciated costs of
mental illness
• Study done in the United States indicated that
direct and indirect costs of mental illness were
equal to 2.5% of GNP
• Significant losses in worker productivity
The Costs and Consequences of
Noncommunicable Diseases, Tobacco
Use and Alcohol Abuse
Hearing and Vision Loss
• Very little data available
• Associated costs could include constraints to the
education of children, school days missed by
children with disabilities, cost of additional
medical visits, high cost of education for students
with hearing loss, difficulties for adults with
finding employment, lower income levels
The Costs and Consequences of
Noncommunicable Diseases, Tobacco
Use, and Alcohol Abuse
Tobacco Use
• Estimates from high-income economies suggest
that costs of smoking range from 0.1% to 1.1% of
GDP
• Economic costs are increasing in low- and
middle-income countries
• Disproportionate impact on relatively poor people
because they tend to smoke at higher rates
The Costs and Consequences of
Noncommunicable Diseases, Tobacco
Use, and Alcohol Abuse
• Health and productivity costs have to take into
account the user as well as anyone that they
might injure
• One study of middle- and high-income
countries found that costs were greater than
1% of GDP
Addressing the Burden of
Noncommunicable Diseases
Tobacco Use
• Taxing cigarettes at higher rates would be
effective for reducing consumption
• Legal restrictions on smoking
• Ban on cigarette advertising
• Biggest impact in high-income settings has
come from comprehensive control programs
Addressing the Burden of
Noncommunicable Diseases
Abuse of Alcohol
• Very few countries have made coherent efforts to
reduce alcohol consumption
• Limiting hours when alcohol can be bought or sold and
checking sobriety of drivers has showed some success
• Taxing can reduce consumption but could lead to
smuggling and consumption of illicit alcohol
• Individual counseling shows some success, but would
be difficult for countries with limited resources
Addressing the Burden of
Noncommunicable Disease
High Blood Pressure, High Cholesterol,
and Obesity
• Large-scale health education campaigns to
promote healthier eating habits with greater
intake of fruits and vegetables and less fat and
salt
• Public policies and community layouts that
promote physical activity
Addressing the Burden of
Noncommunicable Disease
Cancer
• Tobacco control is first priority
• Addressing infectious agents associated with
cancer like H.pylori and schistosomiasis
Addressing the Burden of
Noncommunicable Disease
Mental Disorders
• Little progress in low- and middle-income
countries due to lack of understanding, low funds,
and stigma
• Creating a mental health policy and budget is the
first step
• Integrating mental health into community-based
primary care and psychosocial supports instead of
large, centralized hospitals has demonstrated
success
Future Challenges
• Number of new cases of noncommunicable
disease will grow because of aging,
urbanization, globalization and lifestyle
changes
• Number of people with disease will also rise
because the diseases are chronic
• Low-income countries will have to deal with
communicable and noncommunicable disease
simultaneously, as well as with injuries